Compliance Auditor - Hospital Services

Location:Westlinks -12801 Westlinks Drive Fort Myers FL 33913

Department: Compliance

Work Type: Full Time

Shift: Shift 1/8:00:00AM to 4:30:00PM

Minimum to Midpoint Pay Rate:$33.37 - $45.05 / hour

Summary

The Compliance Auditor will assist in the overall compliance audit and investigative activities to ensure organizational compliance with applicable laws, regulations, and standards of conduct. This person will conduct planned audits, probe audits, chart reviews and contribute to the annual Compliance risk assessment. The Compliance Auditor will also verify reimbursement and/or coding when appropriate. The Compliance Auditor will help complete compliance work plans and provide staff education and internal guidance to operational departments. This person also will investigate compliance and ethical concerns, such as reports of fraud, waste, and abuse.

Requirements Educational Requirements Degree/Diploma Obtained Program of Study Required/
Preferred and/or AssociatesNursingRequiredor BachelorNursingPreferredand Additional Requirements Experience Requirements Minimum Years Required Area of Experience Required/
Preferred and/or 5 YearsClinicalRequired Additional Requirements

Five years of clinical experience and knowledge of health system operations. Prior regulatory compliance or audit experience preferred.

State of Florida Licensure Requirements Licenses Required/
Preferred and/or Registered Nurse LicenseRequired Certifications/Registration Requirements Certificates/Registrations Required/
Preferred and/or Additional Requirements

Coding Certification (CCA, CCS, CCS-P, CPC,or CPC-H) required within one (1) year of hire. Compliance certification (CHC) required within two (2) years of hire.

Other Requirements

Strong research skills and knowledge of clinical quality concepts, medical necessity, clinical documentation, and medical terminology. Knowledgeable in compliance-oriented tasks including reviewing coverage determinations, Medicare materials, final rules, regulations, and organizational policies, preferred. Ability to handle multiple tasks and demonstrate good communication skills preferred. Proficient in the use of Microsoft Office programs and ProDiver reporting application preferred.

US:FL:Fort Myers